"Our blood is not pure enough": a qualitative study to understand systemic racial barriers to blood donation for Black people in Canada.

Abstract

Blood donation supports critical treatments; however, Black people in Canada face multiple barriers to donating blood. We aimed to explore these barriers to better understand how to enhance donor diversity and equitable health care access. We conducted a qualitative study with semi-structured in-depth interviews with Black adults living in Canada. We recruited participants through social media and community organizations. We transcribed, coded, and thematically reviewed interviews using NVivo software. We used Braun and Clarke's 6-step thematic analysis, ensuring cultural sensitivity, to analyze data. We interviewed 42 participants (57.1% women). We identified 14 key themes grouped into 5 clusters that highlighted barriers to blood donation for Black people in Canada. Systemic and policy barriers, which were most commonly cited, included restrictive blood donation policies adopted by Canadian Blood Services and Héma-Québec, institutional racism, and historical anti-Black racism. Knowledge and awareness barriers encompassed lack of information, perceptions of underutilization of Black donors' blood, and exclusionary outreach. Accessibility and practical barriers included inaccessible donation centres and financial constraints. Social and cultural barriers included stigma, lack of representation among staff, and unwelcoming environments. Psychological barriers involved fear of needles and mistrust in the system, which was widespread among participants. Our findings highlight ongoing, restrictive policies that challenge blood donation among Black people in Canada and underscore deep mistrust in the health care and blood donation systems owing to historical and current racial discrimination. Policy reform, inclusive communication, and collaboration between health care organizations and Black communities are needed to improve trust.